Re: Thrombophylia and recurrent abortions

From: D. Ashley Hill, MD (dahmd@cfl.rr.com)
Tue Jul 2 09:23:54 2002


Recently a patient requested confirmation that the "dose" of progesterone cream she was using was adequate for "fetal support" in the first trimester. She has no prior miscarriage history, and has no evidence of luteal phase defect. She told me "everybody knows that 70% of miscarriages are due to lack of progesterone" so she and her friends take this over-the-counter preparation to prevent miscarriage. I explained that inadequate progesterone was a possible cause of about 5% of miscarriages, and that progesterone supplementation is a controversial subject. She didn't buy it, and decided to increase the amount. Once again, inadequate or incorrect information leads to poor consumer choices.

Ashley

>-----Original Message-----
>From: Dr. Rupak Ranjan Roy [mailto:rupakroy@vsnl.com]
>Sent: Monday, July 01, 2002 9:13 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Thrombophylia and recurrent abortions
>
>I agree with Dr. Raymond about the cause of first trimester
>miscarriages.
>So, why this gonadotrophin and progestogen business? These are not known
>to
>be helpful. But, in our country (and I suspect Egypt is no exception)
>the
>pharmaceutical companies promote these drugs vigorously and
>unfortunately a
>majority of the doctors also prescribe them at the slightest hint of a
>miscarriage. This has gone so much out of hand that nowadays patients
>sometimes demand that she be given injections to prevent miscarriage. I
>now
>have a patient in her third pregnancy with two previous early
>miscarriages,
>who has started to bleed. The ultrasound scan has showed a viable fetus
>and
>I am just reassuring her. But she phones me every night and asks for
>something to be given to her (something that was prescribed to her
>friend
>with a good outcome). This way wrong concepts can take over.
>I personally never prescribe progestogen support or gonadotrophins. The
>argument I use with the patient is that if these drugs ARE helpful, then
>all
>you are doing is continuing with a chromosomally abnormal pregnancy.
>
>Dr. Rupak Ranjan Roy
>MRCOG
>

>>>----- Original Message -----
>From: "Steve & Eryl Raymond" <eryl@intekom.co.za>
>To: "Multiple recipients of list OB-GYN-L"
><ob-gyn-l@mail.medispecialty.com>
>Sent: Monday, July 01, 2002 3:03 PM
>Subject: Re: Thrombophylia and recurrent abortions
>
>> Can you give evidence either in the literature or from studies you
>have
>done to
>> support the opinion that most 1st trimester losses are due to
>deficient

--
D. Ashley Hill, MD
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency
Orlando, Florida




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